Provider Demographics
NPI:1558780601
Name:WEXLER, BRIAN BALLARD
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:BALLARD
Last Name:WEXLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 SPRUCE ST
Mailing Address - Street 2:HOSP OF UPENN, DEPT OF EMERG. MED., GROUND FLOOR RAVDIN
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4238
Mailing Address - Country:US
Mailing Address - Phone:215-662-6305
Mailing Address - Fax:215-662-2875
Practice Address - Street 1:3400 SPRUCE ST
Practice Address - Street 2:HOSP OF UPENN, DEPT OF EMERG. MED., GROUND FLOOR RAVDIN
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4238
Practice Address - Country:US
Practice Address - Phone:215-662-6305
Practice Address - Fax:215-662-2875
Is Sole Proprietor?:No
Enumeration Date:2014-04-15
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT205981207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine